Patients Lead The Way As Medicine Grapples With Apps

How many calories in that bite? My Fitness Pal and other fitness and nutrition apps can help find the answer.

Heather RousseauNPR

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Originally published on June 18, 2013 9:39 pm

Christine Porter is hooked on the MyFitnessPal app. In October, after deciding to lose 50 pounds, Porter started typing in everything she eats, drinks and any exercise she gets.

"This is my main page here," says Porter. "It's telling me I have about 1,200 calories remaining for the day. When I want to record something I just click the 'add to diary' button. I'm on it all day either through my phone or through the computer."

She says she's lost 42 pounds in nine months.

Health apps like MyFitnessPal are turning smartphones and tablets into exercise aids, blood pressure monitors and even devices that transmit an electrocardiogram. But the explosion of apps is way ahead of tests to determine which ones work.

Porter heard about the fitness app from Ryan Sherman, her health coach at a clinic for employees of Massachusetts General Hospital. Sherman helps peoople turn a doctor's orders into action for keeping high blood pressure or sugar levels in check.

Increasingly, says Sherman, patients with diabetes or heart problems are coming in, pulling out their phones, and saying, "Hey, have you seen this app?"

"There's a new one every day, so it's trying to keep up with that," Sherman says.

That's one reason why many doctors are suggesting, but not prescribing apps.

Doctors aren't sure which of the roughly 40,000 available apps do what they claim to do. The Food and Drug Administration divides health apps into two categories: those that help with healthful lifestyles and those that turn your phone into a medical device to, say, record blood pressure or an EKG, and then send those readings to a doctor.

The FDA is working on regulations for the mobile medical apps that can turn a mobile platform into a medical device. It does not plan to regulate diet or exercise apps. A few private companies are stepping in to do that task. Ben Chodor started Happtique, a company that reviews apps and gives those that at least perform correctly a seal of approval.

"It's the Wild West and someone needs to come in and at least help the consumers and the clinicians and the payers sort through the forty thousand-plus apps that are already out there," says Chodor.

Happtique does not say which apps work better than others or guarantee their safety.

Still, Eric Topol, a cardiologist who directs the Scripps Translational Science Institute in San Diego, says apps that monitor blood pressure or glucose rates can be more valuable than prescriptions to keep these conditions in check.

"When we use a medication, we don't know if it's going to work or not. It's much better when a person's taking their blood pressure on a frequent basis," says Topol. "The average person looks at their smartphone 150 times a day, so all of a sudden they're able to diagnose if their blood pressure's adequately controlled and what are the circumstances when it's not."

But Laura Ferris, a dermatologist at the University of Pittsburgh, urges patients to use apps cautiously. "It does make sense that people who download these apps and use them really understand that they are doing so at their own risk," says Ferris.

Ferris ran a study of apps that claim to detect skin cancer based on a picture of a mole. Only one of the apps sends the picture to a dermatologist. It was right 98 percent of the time.

Three others, say Ferris, could be dangerously wrong. "The best of them missed melanoma 30 percent of the time," she says. "The worst of them missed melanoma over 90 percent of the time."

And many unresolved questions swirl around the data collected by medical apps, including whether the information patients collect become part of their medical record, how would this work, and what will insurance cover.

Health apps are turning our phones and tablets into exercise aides, blood pressure monitors, even EKG transmitters. But apps like those have proliferated far more rapidly than tests to determine which apps actually work.

CHRISTINE PORTER: This is like my main page here. So it's telling me that I have, you know, about 1,200 calories remaining for the day.

BEBINGER: In October, after deciding to lose 50 pounds, Porter started typing in everything she eats, drinks, and any exercise she gets.

PORTER: When I want to record something I just click the Add to Diary button. I'm on it all day, either through my phone or through the computer.

BEBINGER: Porter heard about the app from Ryan Sherman, her health coach, who turns a doctor's orders into a user-friendly action plan for keeping high blood pressure or sugar levels in check. Increasingly, says Sherman, patients with diabetes or heart problems are coming in, pulling out their phones, and saying hey, have you seen this app?

RYAN SHERMAN: There's a new one every day, so it's trying to keep up with that. And if there's not one place to really look, that can be hard.

BEBINGER: Which is one reason why many docs are suggesting but not prescribing apps. Doctors aren't sure which of the roughly 40,000 available apps do what they claim to do. The U.S. Food and Drug Administration divides health apps into two categories. There are those that help with healthy lifestyles and those that turn your phone into a medical device, say, to take blood pressure or an EKG, and then sends those readings to a doctor.

The FDA is revising regulations for apps in the medical device category. It does not plan to regulate diet or exercise apps. A few private companies are stepping in. Ben Chodor started Happtique, a company that reviews apps and gives those are at least perform correctly, a seal of approval.

BEN CHODOR: It's the Wild West and someone needs to come in and at least help the consumers and the clinicians and the providers and the payers at least sort through the 40,000-plus apps that are already out there.

BEBINGER: Happtique will not say which apps work better than others or guarantee their safety. Still, some doctors say apps that work are transforming medicine. Dr. Eric Topol, the chief academic officer at Scripps Health in San Diego, says apps that monitor blood pressure or glucose rates can be more valuable than prescriptions to keep these conditions in check.

DR. ERIC TOPOL: Because when we use a medication, we don't know if it's going to work or not. And so, it's much better when a person is taking their blood pressure on a frequent basis. The average person looks at their Smartphone 150 times per day. And all of a sudden, they're able to diagnose if their blood pressure's adequately controlled and what are the circumstances when it's not.

BEBINGER: Topol says apps that control blood pressure will help prevent strokes and heart attacks and may mean doctors should prescribe phones and tablets in addition to apps. But Dr. Laura Ferris, at the University of Pittsburgh, urges patients to use apps cautiously.

DR. LAURA FERRIS: It does make sense that people who download these apps and use them really understand that they are doing so at their own risk.

BEBINGER: Ferris ran a study of apps that claimed to detect cancer based on a picture of a mole. Only one of the apps sends your picture to a dermatologist. It was right 98 percent of the time. Three others, says Ferris, could be dangerously wrong.

FERRIS: The best of them missed melanoma 30 percent of the time. The worst of them missed melanoma over 90 percent of the time.

BEBINGER: There are many unresolved questions about health care apps. Should all the information patients collect become part of their medical record and how? Who in the doctor's office analyzes all a patient's numbers? Will insurers cover the cost of apps?

Dr. Ben Crocker, at the Mass General clinic that is testing a few apps, says those are questions doctors will have to answer because...

DR. BEN CROCKER: This is what's engaging patients. Patients are coming to their doc for the first time, or their team, saying: I've been collecting some information or I've been using this application. And that, I think, we can't ignore, no matter where this is taking us, no matter how Wild West it feels.

BEBINGER: So download away, but be careful as we continue this adventure with mobile health.

For NPR News, I'm Martha Bebinger in Boston.

SIEGEL: And that story comes from a collaboration of NPR, WBUR and Kaiser Health News. Transcript provided by NPR, Copyright NPR.